Policy Mismatch: Why Behavioral Health Infrastructure Needs a Digital Policy Overhaul

Behavioral health access is often framed in terms of workforce shortages. However, that leaves out a critical part of the story that goes beyond a lack of providers. Every day, people struggle to find care because the systems surrounding those providers are disconnected, inefficient, and unreliable.

Behind the scenes, behavioral health providers still rely on manual work like sending faxes and phone calls to verify coverage. A therapist might be ready to see a new patient, but the patient’s benefits are managed by a separate behavioral health vendor with its own network that requires separate approval. That complexity leads to canceled appointments and delays treatment. The patient never gets through the front door.

Much of this fragmentation is rooted in policy decisions made decades ago. Starting in the 1980s, mental health services were carved out from general medical plans. Later, when federal investments digitized health care through the HITECH Act, behavioral health providers were excluded from those incentives. As a result, many community clinics and solo practices still operate without modern electronic health records (EHRs). Information does not flow and authorizations take days. Insurance directories list providers who are no longer accepting patients (“ghost networks”). Even when someone has coverage, they often cannot find care that matches it.

Emergency departments absorb the consequences. Patients in psychiatric crises arrive at hospitals and remain there long after they are stabilized. In California alone, there’s a shortfall of more than 7,700 beds for people with behavioral health needs, 550 people each day remain in inpatient psychiatric care even when ready for discharge, and 92% of hospitals that provide psychiatric inpatient care cannot admit new patients because discharging current patients is too difficult. Amidst this backlog, referrals stall and insurance approvals lag. Real-time bed tracking might be unavailable. That’s why patients wait while hospital staff scramble to find the next step.

Policy continues to shape these barriers. A recent House proposal would require states to verify Medicaid eligibility every six months instead of every twelve. That change would increase churn and coverage gaps. For individuals with serious mental illness, a short lapse in coverage can interrupt recovery by disrupting treatment and delaying prescriptions.

At the same time, enforcement of new parity rules under the Mental Health Parity and Addiction Equity Act has been paused. The rule would have required health plans to prove that their management of behavioral health benefits is not more restrictive than their medical benefit practices. Without that accountability, behavioral health continues to face tighter controls and narrower networks, along with more frequent denials.

These problems are not theoretical. They play out in canceled therapy appointments, missed follow-ups after hospitalization, and longer emergency room stays. They waste clinical time and frustrate families. They also push clinicians out of network, reducing access even further.

Solutions do exist. A modern behavioral health system would start with electronic infrastructure that matches what general medical care already uses. Coverage verification would be instant and digital. Behavioral health providers would use interoperable EHRs. Referral systems would show real-time availability. Privacy laws would support coordination of care while preserving patient protections.

Policy can make this possible. Federal programs like the Innovation in Behavioral Health model are already beginning to invest in health IT and care integration for community providers. These efforts could be expanded through sustained funding and regulatory support. Aligning 42 CFR Part 2 with HIPAA would help providers share information about substance use care without unnecessary barriers. States and payers could adopt common standards for prior authorization and invest in shared scheduling platforms.

Delivery models also offer guidance. Certified Community Behavioral Health Clinics provide care regardless of diagnosis, income, or insurance status. They serve as centralized entry points that reduce fragmentation. The Collaborative Care Model integrates mental health services into primary care, allowing more patients to get help without relying on scarce psychiatric specialists. These models improve patient outcomes and make better use of the existing workforce.

Policy change can also address continuity.  For example, continuous Medicaid eligibility would reduce treatment interruptions. A national bed registry would reduce unnecessary hospital stays. Centralized referral systems would prevent patients from getting lost between providers. However, these practical changes depend on political will and policy alignment.

Current infrastructure was not built for coordinated behavioral care because it was assembled around separate funding streams and outdated systems. That separation creates blind spots where patients get stuck in limbo. Providers spend more time on paperwork than on care, and health systems end up carrying the cost of inefficiency. The consequences touch nearly every corner of the healthcare system.

Behavioral health care deserves the same infrastructure, standards, and support that we apply to medical care. That means investing in technology, enforcing parity, and writing policy that reflects how people actually move through the system. Better infrastructure can mean faster referrals, fewer denials, shorter hospital stays, and more time for treatment. None of that requires reinventing care, but it does require aligning with the system around it.

Policy created these barriers. Policy can remove them. There is no shortage of ideas. The question now is whether we are willing to build the infrastructure behavioral health has always needed.